We already know that women with diabetes have a substantially increased risk of adverse pregnancy outcomes. We also know that improved glycaemic control can reduce these risks. But are these messages being adequately addressed in current clinical practice?
The NHS in England has recently started the National Pregnancy in Diabetes Audit, with the aim of helping clinical teams to deliver better care to pregnant women with diabetes
Proof of concept studies have previously highlighted the most important barriers to proper audit: logistical issues, poor IT infrastructure and lack of resources. The NPID aims to minimise these additional burdens by making as much use as it can of existing data sources, particularly from diabetes and pregnancy programmes.
The areas addressed by the audit are:
Are women with diabetes adequately prepared for pregnancy?
- Taking folic acid at conception?
- Taking potentially teratogenic drugs at conception?
- Achieving optimal blood glucose control at conception?
Are appropriate steps taken during pregnancy to minimize adverse outcomes?
- Were target HbA1c levels achieved?
- Was retinal screening carried out?
- Were other maternal risk factors identified?
Did any adverse outcomes occur?
- Deterioration of maternal retinopathy
- Acute maternal admission
- Live birth
- Congenital anomaly
- Perinatal death
- Admission for neonatal care
This initiative will enable us to build a comprehensive picture of the quality of diabetes care in pregnancy. Patients, carers and commissioners can work together to improve the service for future generations and minimise the risks of harm from diabetes in pregnancy.
Visit the NPID website for full details of the programme, to register for data entry and to download guidance notes, participation information leaflets and consent forms.
Murphy HR, Bell R, Hold RIG et al. The National Pregnancy in Diabetes Audit: measuring the quality of diabetes pregnancy care. Diabetic Medicine 2013; 30:1014-6. [PubMed record]